The Bitter Pill

We live in a VUCA world. What is VUCA, you ask? Developed as an operational construct by the United States Army in the late 1990s, VUCA describes the world in four adjectives: volatile, uncertain, complex, ambiguous. Since 9/11, VUCA has taken on new meaning for the military, and the world, with deeply imbedded dilemmas.

Since 2010, the year the Affordable Care Act (ACA) was signed into law, VUCA, as it relates to the healthcare industry, has taken on new meaning with deeply imbedded dilemmas. Here is the reality: the dilemmas are not going away any time soon. Further, they are magnified because one of the realities of healthcare is that our doctors have been trained to practice the art (and science) of medicine but not the business of healthcare.

Healthcare enterprises are focused on transforming the way healthcare is delivered across the entire care continuum, including shining the spotlight of reality on the cost structure, improving data transparency, aligning clinical and financial outcomes, improving quality and increasing preventive care.There is no argument these types of things need to be done. The question is who will lead these efforts. The answer: physician leaders.

The challenge we face is that the traditional care delivery model focused on physicians as autonomous craftspeople with practices centered around a specialization. This is one reason why 60 percent of doctors are either specialists or surgeons. To drive and sustain needed changes, we need leaders who understand the changing business of healthcare.

And, by the way, don’t confuse being a leader with big roles such as the CEO. We need engaged, adaptive and collaborative leaders at every level of the organization. In short, we need to turn doctors into leaders.

We need a fundamentally different approach to developing leaders. And, lest we forget, developing leaders is a journey, not an event. As an example, the premier leadership development institution in the world is the United States military. No other institution devotes more time, energy and money to developing future leaders. The Army does this by focusing on developing leaders of character and competence using a three-pronged approach consistently executed over time. Notice that the focus is on both character and competence. I think most seasoned and effective leaders would strongly agree that the character and the competencies of leaders are important — both are needed to sustain personal and organizational excellence. Why? Because the way leaders get results matters….a lot.

The Army simplifies the developmental message by using the phrase, “Be, Know, Do.” One’s character, underpinned by values, describes what leaders should “BE” (your value system drives behaviors and you demonstrate your character by the way you behave). The skills a leader needs demonstrate what a leader must “KNOW” (interpersonal skills, conceptual skills, technical and tactical skills). And, finally, leaders must have a bias for action to deliver results — the “DO” (influencing, making decisions, accomplishing the mission, continuous improvement). This framework encourages developing leaders by leveraging a variety of educational experiences, planning and staff roles, as well as, positional roles that challenge one’s character and competencies.

How long does it take the Army to develop a seasoned combat leader? Over the course of 15 to 20-years — developing leaders is a journey supported by a progressive set of experiences that stretch the thinking, innovation and application of key ideas and concepts. In short, the most effective leaders are developed over a long period of time.

Where do we start? Rather than rattling off the latest book, model or research paper, let’s start developing physician leaders at the beginning —with one’s self. For many physicians it’s a bitter pill to swallow because it requires looking in the mirror not out the window. Let’s start by clearly identifying the types of future leaders we need and what we want them to BE and then developing a construct that brings that BE to life.

Keith Thurgood

Keith Thurgood is a clinical professor of healthcare leadership and management at the Jindal School, where he also leads the executive MS program in healthcare leadership and management and is an adjunct professor of marketing and entrepreneurship. In addition to his responsibilities at UT Dallas, Dr. Thurgood is a faculty member and senior advisor for the Thayer Leader Development Group in West Point, New York, and a retired Army major general.
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